Patient factors

When sufficient evidence is available to determine that the patient has real seizures and is at risk for another seizure, pharmacotherapy is usually started (Fig. 27-2). The patient should be in agreement with the plan, be willing to take the medication, and be able to monitor seizure frequency and adverse drug effects in some way. Design of an appropriate pharmacotherapeutic plan is based on the patient s seizure type, the common adverse-effect profile of possible AEDs, and economic factors (e.g., cost of the drug, insurance formulary, and ability to pay). Other patient factors such as gender, concomitant drugs, age, and lifestyle also need to be considered. 

Recommend a pharmacologic plan for OA, taking into consideration individual patient factors. 

Nonsteroidal anti-inflammatory drugs, colchicine, or corticosteroids are used for acute attacks. Selection depends on several patient factors, especially renal function. 

Assess the need for continuous antihyperuricemic therapy. Use patient factors such as comorbidities to select an agent. Allopurinol is the standard prophylactic agent used in the United States. 

Patient factors that need to be considered include age, renal function, drug allergies and/or drug intolerances, immune... 

Cefazolin or cefuroxime are appropriate for prophylaxis in cardiothoracic and vascular surgeries. In the case of 3-lactam allergy, vancomycin or clindamycin are advised. Debate exists on the duration of antimicrobial prophylaxis. The National Surgical Infection Prevention Project cites data that extending prophylaxis beyond 24 hours does not decrease SSI rates and may increase bacterial resistance.1 American Society of Health-System Pharmacists guidelines from 1999 allow for the continuation of prophylaxis for up to 72 hours.22 Duration of therapy should be based on patient factors and risk of development of an SSI. SSIs are rare after cardiothoracic operations, but the potentially devastating consequences lead some clinicians to support longer periods of prophylaxis. 

Second-line or salvage therapy is based on type of and response to prior treatments, site and extent of disease, and patient factors and treatment preferences (see Table 62-2). The optimal sequence of regimens has not been established. 

Detecting the incidence and type of adverse drug events (ADEs) and medication errors is important for improving the quality of health care delivery. Problems include missing dose, wrong dose, frequency, and route errors. The consequence (ADE) of the errors depends on medication and patient factors as described previously. Some of these problems are organisational and related to chart order system and prescribing. 

IM administration - IM administration may be used as an alternative to the oral route for patients with less threatening arrhythmias but who are nauseated or vomiting, who are ordered to receive nothing by mouth preoperatively, or who may have malabsorptive problems. An initial daily dose of 50 mg/kg may be estimated. Divide this amount into fractional doses of 1/8 to % to be injected IM every 3 to 6 hours until oral therapy is possible. If more than 3 injections are given, assess patient factors such as age and renal function, clinical response and, if available, blood levels of procainamide and NAPA in adjusting further doses for that individual. For treatment of arrhythmias associated with... 

Define objectives of treatment before initiation of a drug Note frequency and severity for a drug Dependant on age, disease, and individual patient factors Include drug action, absorption, elimination, and protein binding Are they clinically significant ... 

Risk factors Treatment factors treatment duration > 6 months high dose short-acting drug abrupt cessation Patient factors severe premorbid anxiety alcohol/substance use disorder female dysfunctional personality panic disorder... 

With continued improvement in our understanding of the mechanisms of interactions and contributions of additional patient factors (e.g., genetics... 

The degree of ionization under physiologic conditions Product formulation characteristics Disintegration and dissolution rates for solid dosages Drug release characteristics for timed-release preparations Patient factors... 

In general, multiple (up to 30-40) blood samples can be obtained per subject to measure dmg and metabolite concentrations as well as biomarkers in these phase I clinical trials. Furthermore, pharmacodynamic measurements can be included to get a first impression on the drug effect in humans, however, limited by the fact that healthy volunteers were studied and not patients. As strict inclusion and exclusion criteria are used, the demographic characteristics of the healthy volunteers do not provide sufficient spread to investigate the effect of intrinsic factors. Therefore, phase I trials provide very rich data to develop pharmacokinetic and pharmacodynamic models on biomarker, but cannot be used to develop models for efficacy, safety, influence of patient factors on PK and/or PD and disease progression. 

It is important to monitor peak and trough plasma levels (see p. 20) of gentamicin, tobramycin, netilmicin, and amikacin to avoid concentrations that cause dose-related toxicities (Figure 31.7). [Note Peak levels are defined as those obtained 1/2 to 1 hour after infusion. Trough levels are obtained immediately before the next dose.] Patient factors, such as old age, previous exposure to aminoglycosides, gender, and liver disease, tend to predispose patients to adverse reactions. The elderly are particularly susceptible to nephrotoxicity and ototoxicity. 

These extended case studies complement the basic information presented in Chapters 1 to 40. They reinforce basic principles of pharmacology, such as the role of patient factors in empiric antimicrobial therapy Most of the cases provide clinical information obtained from a single patient some cases describe a composite of typical features derived from several patients. These cases illustrate simple pharmacologic principles, such as consideration of kidney function in drug dosing—concepts useful in answering examination questions, and in the clinics. 

The frequency with which blood concentrations should be measured varies with the stage of the illness and with a number of patient factors (including age, associated illnesses, concomitant medications, and diet). Generally, concentrations are measured every 5-7 days during the start of therapy, and then less and less often as stability occurs and persists. In reliable patients taking long-term treatment, concentrations may be measured every 3-4 or even 6 months. 

Varicella-zoster virus is a member of the Herpesviridae femily. The viral contagion is transmitted via aerosolized water droplets or close physical contact with infected lesions. The primary infection results in varicella or chickenpox. The varicella infection can have potentially devastating ocular sequelae the most common is anterior uveitis followed by SPK. After the primary infection, latent infection occurs in multiple ganglia throughout the body. Herpes zoster is the resultant reactivation of the latent varicella-zoster virus and most often occurs in elderly and immunocompromised patients. Factors such as physical and emotional trauma, immunosuppressive medications, irradiation, cancer, tuberculosis, malaria, and syphilis are known to reactivate the virus. 

Poor data (unreliable fields due to fixation or other patient factors) should be removed from the analysis. 

---